HomeMy WebLinkAbout48815-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 48815 Date: 1/30/2023
Permission is hereby granted to:
Ferris III, William
320 Bittersweet Ln
PO BOX 1174
Cutcho ue NY 11935
To Construct addition and alteration to existing single family dwelling as applied for.
At premises located at:
322 Bittersweet Ln, Cutcho ue
SCTM # 473889
Sec/Block/Lot# 104.-2-7.5
Pursuant to application dated 12/29/2022 and approved by the Building Inspector..
To expire on 7/31/2024.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $496.00
CO-ADDITION TO DWELLING $50.00
Total: _ $546.00
Building Inspector
d rat t40h TOWN OF SOUTHOLD—BUILDING DEPARTMENT
� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 iittps-://www.southoldtownnv,,eov
A
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only I �lP I� II 1UI
Building Ira ectar� "q �. rp
PERMIT NO. g I da
LD
tsUILUING DEP
Applications and forms must be filled out in their entirety.Incomplete 0S0 t I
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorizatlob form(Page 2)shall be completed.
Dater 'y '0 J '2 ZL
OWNER(S)OF PROPERTY:
Name: SCTM# 1000-
Project Address:
3 71
Phone#: _ Email;
�7� 6 L ,
MailingAddress: � , 2 27 f
'c7
CONTACT PERSON:
Name: T. 3 47.1 - LI-
Mailing Address: ( 1% C' Lt /10 J—
Phone#: t -7de-Z burr = Email:
DESIGN PROFESSIONALINFORMATION:,
Name:
Mailing Address: (�' f-0 rf--,3 '-I C T-C-qrz-'� t. '
Phone#: [ - 71 7c J" Email:GSL�� 0'7 twe4 fc A L 4%
�/-9 7-0 z1 41 4t,
CONTRACTOR INFORMATION:
Name: �vrA" Q910 Z-, 0 3i-/
Mailing Address: - G , v //?Os—
Email:
Phone#: 6-31 - S�l�°1 ' .� G C✓ e4 &
DESCRIPTION OF PROPOSED CONSTRUCTION
-........�
❑NterwAStructure Addition ❑Alteration ❑Re air ❑Demolition Estimated Cost off Project:
❑Oe $
Will the lot be re-graded? ❑Yes VNo Will excess fill be removed from premises? �4Yes ❑No
1
IT
PROPE
RTY INFORMATION
f
Existing use of property: . � Intended use of property: �w � o
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? Dyes E�No IF YES, PROVIDE A COPY.
❑ Check BOX After Reading: The owner/contractor/design professional is responsiblefor all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone
ii
Ordinance oithe Town of Southold,'Suffdlk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
,
additions,alterations or for removal or dumormoh is hewn described.The applicant agrees to coniply'uii all applicable laws,ordinances,building code,
housing code;and regulations and to admit authorized inspectors on,premise and In building(s)for necessary inspections.False statements made herein are
punishable as a Class'A'mis lemeanor pursuant to;5ection 210.45 of the New York State Penal Law.,
Application Submitted By(print name)» l�� � °��� .A C4 �r—q ❑Authorized Agent Owner
Signature of Applicant: Date: /,;V
STATE OF NEW YORK)
SS:
COUNTYOF
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
qday of W4'Y1 20 � °" 0��/ d; t,r
Notary Public
CONNIE D. BUNCH
PROPERTY OWNER AUTHORIZATION Notary Public,State of New York
No. 01BU6185050
(Where the applicant is not the owner) Qualified in Suffolk County
rommis�;ion Expires April 14, 2a_�
I, residing at
do hereby authorize —to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
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